1053453852 NPI number — PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS LLC

Table of content: (NPI 1053453852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053453852 NPI number — PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1053453852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 TOWER ROAD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-9403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-218-0219
Provider Business Mailing Address Fax Number:
770-590-4908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 TRANSIT AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-345-5717
Provider Business Practice Location Address Fax Number:
770-345-7852
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
770-427-5717

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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